Its not about the bike

The title of this post was also the title of Lance Armstrong's autobiographical narrative of his fight against almost certain death from testicular cancer and his subsequent return to professional cycling and to the pinnacle of his chosen sport. Recent events have borne Armstrong out to be a liar and a cheat of the highest calibre, however our revulsion at his cowardly acts must be restricted to his sporting achievements. 

The Livestrong Foundation, set up by himself, has raised close to $500 million and provided hope and solace to countless individuals who have battled cancer. As much as all observers and involved persons alike would prefer to black out all reference to Armstrong and damn him to the darkest abyss, such instincts must be curbed for the greater good. Livestrong must be allowed and supported in its good work, and one hopes that Armstrong will have the good grace to disassociate himself from the foundation and allow it to create its own legacy, free from his own tainted and deeply flawed journey.

Another year begins!

A quick word to wish good luck to all pharmacy students on the start of the new academic year, especially to the new entrants!

Lets hope we all get settled pretty quickly and manage to juggle the twin feats of having a good time and getting some productive learning time under our belts.

See you!

John

Why education and business must mix for the greater good

Business interests and the aims of tertiary education are not initially similar or even remotely , related at an initial and cursory first glance. However, upon further evaluation one will come to the conclusion that the two are mutually connected and the possibilities for gain for both parties can lead to a situation where cooperation is the only way forward in the near future.

The current situation in the Maltese Islands is such that various university departments suffer from a chronic lack of funding due the limited resources available and the fact that the University of Malta has little sources of income, save for tuition fees charges to overseas(non-EU) students and certain evening and part-time courses.

Without going into the politics of it all, we are currently punching above our weight, taking into consideration the small pool of students and lecturers at hand, and the quality of graduands has improved greatly.

The next step must involve external funding, on a level to that similar in the United States. Various industry and business leaders often complain of a chronic shortage of quality and specialised graduands. One manner in which this might be solved could be by having  companies sponsor courses in fields where we have little or no current expertise, and then allow  these same companies to offer job opportunities to the students prior to the course completion, even have the students undergo work placements at these companies as part of the course curriculum. Alternatively, companies might be allowed to sponsor a chair in a particular area, and be given the opportunity to promote themselves to students in a regulated environment.

Opponents to this might state that education must never be subservient to financial interests and pressures, and they may be right. However, such an arrangement, or a derivative of the above idea, might be the only way in which our minute country can continue to punch above its weight in the field of tertiary education.

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John Vella B.Pharm. (Hons.) M.Sc.(Pharmacoeconomics)

8, Islets Promenade, Bugibba, SPB2502, Malta

+356-21571649, +356-27571649, +356-99497510

http://www.stsimonpharmacy.com

Breaking News! Statins are safe again!

Up to recently, a majority of studies had  shown no obvious gain  in administering statins to patients who had not experienced a previous cardiac event or were at an elevated risk of cardiac pathology.  These studies had not been widely publicised by the pharmaceutical industry for obvious reasons. 

A preview of the results of a meta-analysis of 27 large studies (175,000 subjects in total) to be published in the Lancet in late 2013 suggests otherwise. According to authors quoted from the University of Oxford, anyone over the age of 50 would benefit from statin therapy. The authors insist that the extra cost of therapy would be outweighed by the savings made by a reduction in cardiac events and subsequent hospitalisation and rehabilitation costs.

The link to the full article is here: http://www.bbc.co.uk/news/health-18091708

Why I refuse to lie down and shut up!

Why I refuse to lie down and shut up!

It is easy enough to go along with the rest of the world and accept what is the present state of affairs as the norm. This is all well and good if one's conscience is at peace and the majority of society is well served. In this case, however, both the former and the latter are not satisfied.

I argue that the formulators of public policy are not being given the right amount of information and professional direction to enable decisions to be taken in their best interest. I argue that public health would be better served if those taking macro health decisions placed the well-being of Maltese citizens ahead of personal, political or corporate gain. I argue that the time has come to take a stand and put forward the case for wholesale reform of the manner in which we apply ourselves to healthcare and its delivery.

I will not rest my case.


John

Does money or patient welfare drive our profession?

An extremely well-written and thought provoking book is The Truth About The Drug Companies: How They Deceive Us And What To Do About It, by Marcia Angell. Dr. Angell is a former editor of the New England Jounrnal of Medicine and a respected authority in the field of medical and pharmaceutical matters. Her book tackles what she has termed the takeover of the pharmaceutical field by 'big pharma'

Dr. Angell opines that the massive profits generated by the leading pharmaceutical companies are no longer morally justified and sustainable. She argues that truly innovative and socially profitable drugs are now few and far between, and that the current system of patent protection and profit taking is being manipulated by pharmaceutical companies, to the detriment of the general public. Her arguments are well reasoned and backed up by fact and lead one to give a certain credence to her thesis.

In this light, an introspective view at the manner in which we conduct our profession is warranted. Do we, as Dr. Angell so well describes in her writing, take every word and advertised fact proposed by drug companies as being incontrovertibly right? Do we question research we are quoted and probe the efficacy of newer and more costly medicinal products? Do we consider the financial implications that pharmaceuticals have on the daily well-being of our patients? Are we placing our own motives for profit, financial or otherwise, before those of the public we are obliged to treat impartially?

The above questions are not easily answered, and as in most situations in life, the pragmatic response is a grey line somewhere down the moral middle. Considering them and applying the consequent thoughts to our daily professional practice can only lead to better application and patient benefit. The above mentioned book is also worth a read as it portrays the pharmaceutical industry in a manner few have had the courage to.

Watch what you drink!!

The study below, from the American cardiac journal Circulation, raises some very troubling points. In short, the study concludes, to a high level of significance, that one sugary soft-drink a day increases the risk of CHD (Coronary Heart Disease) by 20%!

The implications of such a discovery are far reaching. If the findings are substantiated and replicated in further studies, then steps should be taken to have health warnings on the products in question and also to initiate public awareness campaigns. There might also be the possibility of introducing a tax on the raw material for sugar containing drinks, as apart from this new link to CHD they are also directly connected to the increase in the incidence of diabetes mellitus, both locally and also world-wide.

These statements may be considered idealistic in view of the financial clout and lobbying power wielded by the soft-drinks industry, however this must not deter us from pursuing the best course of action required for optimum public health. As with the tobacco industry in the past, no interest is too potent to surpass that of society as a whole.

From Heartwire

A Soda a Day Raises CHD Risk by 20%

Lisa Nainggolan

March 12, 2012 (Boston, Massachusetts) — Sugary drinks are associated with an increased risk of coronary heart disease (CHD) as well as some adverse changes in lipids, inflammatory factors, and leptin, according to a new analysis of men participating in the Health Professionals Follow-up Study, reported by Dr Lawrence de Koning (Children's Hospital Boston, MA) and colleagues online March 12, 2012 in Circulation [1].
"Even a moderate amount of sugary beverage consumption — we are talking about one can of soda every day — is associated with a significant 20% increased risk of heart disease even after adjusting for a wide range of cardiovascular risk factors," senior author Dr Frank B Hu (Harvard School of Public Health, Boston, MA) told heartwire . "The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda, not only in the US but also increasing very rapidly in developing countries."

 

The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda.

The researchers did not find an increased risk of CHD with artificially sweetened beverages in this analysis, however. "Diet soda has been shown to be associated with weight gain and metabolic diseases in previous studies, even though this hasn't been substantiated in our study," says Hu. "The problem with diet soda is its high-intensity sweet taste, which may condition people's taste. It's still an open question whether diet soda is an optimal alternative to regular soda; we need more data on this. "
Hu says water is the best thing to drink, or coffee or tea. Fruit juice is "not a very good alternative, because of the high amount of sugar," he adds, although if diluted with water, "it's much better than a can of soda," he notes.
And Hu says although the current results apply only to men, prior data from his group in women in the Nurses' Health Study [from 2009] were comparable, "which really boosts the credibility of the findings."

Inflammation could be a pathway for impact of soda upon CHD risk
Hu and colleagues explain that while much research has shown a link between the consumption of sugar-sweetened beverages and type 2 diabetes, few studies have looked at the association of these drinks with CHD.
Hence, they analyzed the associations of cumulatively averaged sugar-sweetened (eg, sodas) and artificially sweetened (eg, diet sodas) beverage intake with incident fatal and nonfatal CHD (MI) in 42 883 men in the Health Professionals Follow-up study. Beginning in 1986 and every two years until December 2008, participants answered questionnaires about diet and other health habits. A blood sample was provided midway through the study.
There were 3683 CHD cases over 22 years of follow-up. Those in the top quartile of sugar-sweetened-beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (RR 1.20; p for trend < 0.001) after adjustment for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, body-mass index, preenrollment weight change, and dieting.
Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure, and diagnosed type 2 diabetes only slightly attenuated these associations, which suggests that drinking soda "may impact on CHD risk above and beyond traditional risk factors," say the researchers.
Consumption of artificially sweetened drinks was not significantly associated with CHD (multivariate RR 1.02; p for trend=0.28).
Intake of sugar-sweetened drinks, but not artificially sweetened ones, was also significantly associated with increased triglycerides and several circulating inflammatory factors — including C-reactive protein, interleukin 6 (IL-6), and tumor-necrosis-factor receptor 1 (TNFr1) — as well as decreased HDL cholesterol, lipoprotein (a) (Lp[a]), and leptin (p < 0.02).
"Inflammation is a key factor in the pathogenesis of cardiovascular disease and cardiometabolic disease and could represent an additional pathway by which sugar-sweetened beverages influence risk," say Hu et al.

Cutting consumption of soda is one of easiest behaviors to change
Hu says that one of the major constituents of soda, high-fructose corn syrup, is subsidized in the US, making such drinks "ridiculously cheap" and helping explain why consumption is so high, particularly in lower socioeconomic groups.

 

Doctors should be advising people with heart disease or at risk to cut back on sugary beverages; it's almost a no-brainer.

"Doctors should set an example for their patients first," he stresses. "Then, for people who already have heart disease or who are at high risk, physicians should be advising them to cut back on sugary beverages; it's almost a no-brainer, like recommending that they stop smoking and do more exercise. The consumption of sugary beverages is a relatively easy behavior to change."
And although this particular study included mostly white subjects and there are few data on the risk of cardiovascular disease associated with the consumption of soda in people of other ethnicities, there are data on its effect on type 2 diabetes in these groups, he says.
"It has been shown for minority groups — such as African Americans and Asians — that they are more susceptible to the detrimental effects" of sugary drinks on diabetes incidence, he notes.
The authors report no conflicts of interest.